Physician Resources

As you may know from your experience, it can sometimes be difficult to focus on a multifaceted field such as the many diseases associated with sleep in a patient with multiple co-morbidities. Our expertise and interest in such diseases helps our practice to focus on these conditions in-depth and keep morbidity under control.

We will work with you to ensure quality health care for your patient in timely manner, including faxing all consultative notes to your office and remaining in constant communication so that you are well aware of the patient’s treatment course.

Working together with medical professionals in the community is part our culture. We understand how important it is for your patients to know that the physicians you refer to are competent and will provide personalized attention. We look forward to the opportunity to collaborate with you on the care of your patients.

To refer a patient for a sleep consultation, please fax the form below and the patient demographics/face sheet, a copy of the patient’s insurance card(s) and H&P/last office visit note to: (239) 303-4093.

Imtiaz Ahmad, MD, MPH, FCCP

Education & Training

Imtiaz Ahmad, MD, board certified in Internal Medicine, Pulmonary Medicine and Sleep Medicine, started his medical training in the State University of New York Health Science Center in Brooklyn, NY to complete residency in Internal Medicine and fellowship training in Pulmonary and Critical Care Medicine at the University of Mississippi Medical Center. Upon completion of fellowship, he went on to Harvard to obtain advanced degree and training in clinical research and healthcare management. He also received Masters in Public Health degree from Harvard School of Public Health. He received his medical degree from Dhaka Medical College with outstanding achievement and scholarship.

Current Position

Dr. Ahmad is the Medical Director of Somnas. Here, he focuses on the diagnosis, management and treatment of sleep disorders, as well as conducting clinical research in these fields. He is also the Medical Director at Allergy Sleep & Lung Care.

Board Certifications

Pulmonology

Internal Medicine

Sleep Medicine

Clinical Expertise

Pulmonology

Sleep Medicine

Asthma/Allergy

Past Positions

Abbott Laboratories – Medical Director Abbott Park, IL

Sepracor, Inc. – Consultant Marlborough, MA

Professional Associations

American College of Chest Physicians

American Academy of Sleep Medicine

Society of Critical Care Medicine

About Somnas

Somnas offers state-of-the-art diagnostic options to identify specific sleep disorders and manage them using the latest treatments and therapies with an individualized treatment plan to ensure long-term optimal outcomes. Our practice is focused on helping diagnose and treat daytime sleepiness, difficulty in falling asleep or staying in sleep (insomnia), restless leg syndrome, nightmares associated with acute stress/PTSD, sleep disorder among veterans, and various other sleep disorders.

Sleep well, live well.

The Importance of Sleep Testing With Bariatric Surgery Patients

Obstructive sleep apnea (OSA) is common in morbidly obese patients, with a reported prevalence as high as 45% in obese subjects.1 In fact, according to one study presented at the American Society of Metabolic and Bariatric Surgery, of 359 patients who had preoperative polysomnography, 86% had positive tests, which showed severe OSA in half of the cases.2

Obesity predisposes to and potentiates OSA, which demonstrates the need to diagnose OSA through polysomnography testing as part of the preoperative evaluation for bariatric surgery. Preoperative diagnosis of OSA is important for both perioperative airway management and the prevention of postoperative pulmonary complications.3

Assessment of OSA

Polysomnography remains the gold standard for diagnosis and assessment of OSA. Assessing a patient’s BMI is not a fully diagnostic indicator for OSA. In one study, 40 patients being evaluated for bariatric surgery underwent a polysomnography regardless of symptoms. OSA was present in 71% of patients. The majority of the patients were women whose patient characteristics failed to predict the severity of OSA. For that reason, providers should have a low threshold for ordering a polysomnography as part of the preoperative evaluation for bariatric surgery.4

Preoperative Treatment for OSA

CPAP is the mainstay treatment for moderate to severe OSA and has been shown to improve objective and subjective measures of OSA. Appropriate therapy with CPAP perioperatively would theoretically prevent hypoxic complications associated with OSA.5

CPAP has been shown to be a highly effective treatment if appropriately used. Medical literature demonstrates that CPAP can also lead to an improvement in hypertension, especially for patients with moderate to severe OSA.4

Postoperative Treatment for OSA

Data in the literature demonstrates subjective improvement in symptoms of OSA after bariatric surgery, including improvement in self-reported postoperative sleep quality and the reduction in daytime sleepiness. Improvement in validated quality of life scores was shown after bariatric surgery.7

Continuous pulse oximetry (in a critical care or step-down unit or by a dedicated, appropriately trained professional observer in the patient’s room) is felt to reduce the likelihood of complications among patients with OSA.8

Another report recommends continuous monitoring should be maintained for as long as patients remain at increased risk and for at least 3 hours beyond the standard observation time of their non-OSA counterparts.9

Postoperative use of CPAP should not be viewed as potentially adverse to outcomes following bariatric surgery due to any such concerns, and its use should be employed by bariatric surgeons based on the patient’s pulmonary status postoperatively. The risk of anastomotic complications is not increased by CPAP use in the immediate postoperative period following routine gastric bypass based on the existing literature.10 In fact, the risk for prolonged or repeat hospital stays is reduced with CPAP treatment.

Conclusion

Untreated OSA is a comorbidity observed with high prevalence in the bariatric patient population that leads to increased mortality and increased medical disability from several cardiovascular diseases.

Polysomnography is recommended prior to bariatric surgery to determine the if OSA is present and manage symptoms prior to surgery.

Appropriate follow up with a sleep medicine physician is needed to ensure postoperative compliance with CPAP treatment. Management of OSA after bariatric surgery can help aid in postoperative weight loss in the long term.

Obstructive Sleep Apnea and Cardiovascular Disease

Sleep-related breathing disorders are highly prevalent in patients with established cardiovascular disease. Obstructive sleep apnea (OSA) affects an estimated 22 million adult Americans1 and is present in a large proportion of patients with hypertension and in those with other cardiovascular disorders, including coronary artery disease, stroke, tachycardia, cardiac arrhythmias, congestive heart failure and atrial fibrillation.2

Introduction

Quantity and quality of sleep show secular trends alongside changes in modern society, reducing the average duration of sleep across westernized populations with increased reporting of fatigue, tiredness, and excessive daytime sleepiness. Too little or too much sleep are associated with adverse health outcomes, including hypertension and other cardiovascular disorders.3

Obstructive Sleep Apnea (OSA) and Cardiovascular Disease Correlation

Obstructive sleep apnea (OSA) is characterized by repetitive interruption of ventilation during sleep caused by collapse of the pharyngeal airway. A diagnosis of OSA is accepted when a patient has an apnea-hypopnea index (AHI; number of apneas and hypopneas per hour of sleep) >5 and symptoms of excessive daytime sleepiness.

Available data indicate that OSA prevalence is 2 to 3 times higher in patients with cardiovascular disease.4 Obstructive apneas may induce severe intermittent hypoxemia and CO2 retention during sleep, with oxygen saturation sometimes dropping to ≤60%, disrupting the normal structured autonomic and hemodynamic responses to sleep.5

The relationship between duration of sleep and vascular events is U-shaped, suggesting that different mechanisms may operate at either end of the distribution of sleep duration.6

In a systematic review of prospective population-based studies from 1966–2009, one study aimed to assess the relationship between duration of sleep and morbidity and mortality from coronary heart disease (CHD), stroke, and total cardiovascular disease (CVD).

This study showed an increased risk of developing or dying from CHD and stroke on either end of the distribution of sleep duration. Pooled analyses indicate that short sleepers have a greater risk of CHD and stroke than those sleeping 7–8 hours per night. Furthermore, long sleepers also show an increased risk for these events, confirming the presence of a U-shape association, with some heterogeneity among studies for CHD and CVD outcomes, no presence of publication bias, high statistical power, no difference between men and women, or by the duration of follow-up.7

Another respective study explored the incidence of CVD in a consecutive sleep clinic cohort of 182 middle-aged men (mean age, 46.8 ± 9.3; range, 30–69 years in 1991) with or without obstructive sleep apnea (OSA) throughout a period of seven years. The study concluded that the risk of developing CVD is increased in middle-aged OSA subjects independently of other risk factors like age, BMI, and smoking. Furthermore, the study concluded that efficient treatment of OSA reduces the excess CVD risk and may be considered also in relatively mild OSA without regard to daytime sleepiness.8

A systematic review of literature published in the Annals of Thoracic Medicine aimed to summarize a broad array of the pathophysiological mechanisms underlying the relationship between OSA and cardiac arrhythmias to assess the effects of OSA treatment on the presence of cardiac arrhythmias. The association between OSA and arrhythmias was first documented over 30 years ago. Since then, the literature has concluded that individuals with severe OSA were found to have two-to-fourfold higher odds of complex arrhythmias than those without OSA.9

Conclusion

Special emphasis should be given to recognizing the patient with cardiovascular disease who has coexisting sleep apnea to identifying strategies for co-management to best serve the patients needs. A board certified sleep medicine physician is best suited to work with you and your patients to determine an appropriate treatment plan.

SOMNAS and Allergy Sleep & Lung Care are dedicated to improving and maintaining the health status of our patients by providing compassionate, top-quality care. A patient’s special needs, concerns, and lifestyle, and those of their family, will guide our treatment planning. The care our patients receive with us will be on par with the highest national standards.

SOMNAS Sleep and wake disorders center offers state-of-the-art diagnostic options to identify specific sleep disorders and manage them using the latest treatments and therapies in an individualized treatment plan. Our office will work with your patients, communicating every step of the way for the overall health and wellbeing of your patients.